Rachel Aviv’s first book explores questions of self-knowledge and mental health, subjects she’s previously examined in her award-winning journalism for The New Yorker. Strangers to Ourselves: Unsettled Minds and the Stories That Make Us is a stunning book, offering sensitive case histories of people whose experiences of mental illness exceed the limits of psychiatric terminology, diagnosis and treatment.
Aviv begins with her own experience as a 6-year-old who stopped eating or drinking, for reasons she can no longer remember. She was eventually diagnosed with anorexia, the youngest child in the U.S. to receive such a diagnosis, and hospitalized for “failure to eat.” At the hospital, she met anorexic girls twice her age and learned to mimic their strategies for losing weight. But which came first: the diagnosis or her symptoms? This misfit between psychiatric terminology and lived experience is the core issue driving Aviv’s subsequent chapters.
Western psychiatry has a long history of ignoring how issues of racial violence and systemic oppression drive mental illness. Aviv’s reporting on Naomi, a woman experiencing psychosis, grounds Naomi’s mental illness in the intergenerational trauma she has experienced as a Black woman, which has been largely ignored by the institutions that have offered her treatment. Western psychiatry, as developed within a white European framework, also fails to account for cultural difference, as in the case of Bapu, a devout Hindu. Bapu’s mystical visions of ecstatic union with Krishna could be reduced to symptoms of schizophrenia, but to categorize them as such would be to ignore how Bapu herself interprets these visions and how they are understood by other Hindu worshippers.
Other chapters show how painfully limited and limiting psychiatric language is when measured against a person’s own sense of themself, a pressing issue in the context of the overmedication of young people. When adolescents are prescribed multiple medications for anxiety and depression, they risk—as in Aviv’s final case history—limiting their self-definition to the diagnoses they have received.
Strangers to Ourselves is a compassionate and necessary exploration of the complex relationship between how we understand ourselves and how psychiatric diagnoses define us.